Perioperative predictors and clinical outcome in early and late ICU discharge after off-pump coronary artery bypass surgery

The duration of ICU [intensive care unit] stay in cardiac surgery patients has an important role in the rate of complications and costs. The aim of this study was to determine the role of perioperative risk factors in clinical outcome based on the time of ICU discharge. In this descriptive study, 219 patients undergoing off-pump coronary artery bypass [OPCAB] surgery in Afshar Hospital in Yazd, an Iranian city, were divided into early [24 hrs] ICU discharge groups according to the duration of ICU stay. The preoperative, intraoperative and postoperative risk factors, the complications and the outcome were evaluated. Age, sex, hyperlipidemia, diabetes mellitus, previous myocardial infarction, renal failure, cerebrovascular accident, and level of hematocrit and creatinine were not significantly different between the two groups. Patients with hemodynamic instability, respiratory dysfunction, ejection fraction <35%, hypertension, inotrope administration, left main coronary artery involvement, use of intraaortic balloon pump [IABP] and arrhythmia had significantly higher mortality and longer ICU stay [>24 hrs] compared to others [P value <0.05]. The duration of intubation was significantly lower in the early discharge group [7.8 +/- 3.8 hrs compared to 17 +/- 9.9 hrs] than in the late discharge group. Time of ICU discharge depends on perioperative risk factors, and risk factor modification may improve clinical outcome

Clinical outcome and cost in patients with off-pump vs. on-pump coronary artery bypass surgery

General concept and major emphasis on off-pump coronary artery bypass surgery [OPCAB] is maintaining quality of care and patient safety while reducing cost and resource utilization. OPCAB probably avoids the potential complications of cardiopulmonary bypass. However its acceptance depends on clinical and economic outcome. The aim of this study is to compare clinical and economic outcome of off-pump and on pump coronary artery bypass surgery. This is a report of an analytic cross-sectional study on 304 patients underwent coronary artery bypass surgery that were randomized into conventional on pump and off-pump groups. Variables and costs were obtained for each group and these data were analyzed using parametric methods. There was no difference between the two groups with respect to perioperative and intraoperative patient's variables. OPCAB reduced the need for postoperative transfusion requirement [P<0.05] which was statistically significant and showed a trend towards reduction of morbidity although didn't reach statistical significance [P>0.05]. There were no statistically significant differences in surgical re exploration and length of stay between the two groups. The mean cost for an on pump surgery was 8312000 +/- 2859 Rials per patient that was significantly higher than an off-pump surgery. Based on the findings of this study, clinical outcome has no statistically significant difference between on pump and off-pump CABG but the costs are significantly higher in the on pump group